Project Summary Description: Stroke is the fifth leading cause of death in the US and the number one cause of severe long- term adult disability. In addition to initiatives dedicated to reducing morbidity and mortality associated with stroke outcomes, there are initiatives to reduce stroke risk factors at the community level. In order to reduce the burden of stroke on the population, identifying modifiable risk factors, and demonstrating the reduction of stroke risk through risk reduction efforts is a high priority. While much is known about long-term stroke risk factors, such as hypertension, diabetes, and atherosclerotic disease, much less is known about short-term risk factors, or triggers, for stroke. Infection, particularly severe infection, has been identified as a potential risk factor and trigger for stroke. The role of sepsis as a risk factor for stroke has not been well described. Our recent analyses of administrative datasets has identified sepsis as a risk factor for stroke, however, while there is a low absolute risk of stroke post sepsis, those who are at risk remain at risk up to a year after their sepsis event. Additionally, racial disparities in sepsis and stroke have been identified, with black patients twice as likely to develop sepsis or stroke as white patients. Prior research has found that even while adjusting for poverty or medically underserved areas, black patients remain at higher risk of both sepsis and stroke, indicating a link between racial and geographic disparities with sepsis and stroke. The role racial and geographic disparities play in the relationship between sepsis and subsequent risk of stroke is not well- understood. The overall goal of this project is to investigate sepsis as a risk factor for stroke and identify risk factors of sepsis patients that increase their risk of stroke. The proposed research will use data from the REGARDS study (2003-ongoing), a unique longitudinal, nationally representative sample of people with detailed information on prior stroke comorbidities, post-stroke comorbidities and long-term outcomes. Furthermore, an ancillary REGARDS study investigated sepsis hospitalizations, providing valuable information on sepsis hospitalizations that can be investigated as risk factors for stroke. Individual and community level characteristics will be investigated, as well as potential interactions that increase the risk post-sepsis for stroke. The proposed NINDS Small Research Grant will allow us to investigate the role of sepsis as a risk factor for stroke, and identify characteristics of sepsis patients at greatest risk for a stroke, which can aide in patient selection for future research on decreasing the risk of stroke post sepsis in at risk individuals.